4-Disclosure of Relationships.pdf
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- Solicitation number
- 2025056
- Issued by
- Indian River County, Florida
About this file
This document is a Disclosure of Relationships form for Indian River County, Florida, specifically designed to transparently disclose potential conflicts of interest between a business entity and county commissioners or employees. The form requires detailed information about familial and professional relationships, including affiliates such as officers, directors, executives, partners, shareholders, employees, members, and management-level agents who might have connections to county personnel.
The form mandates disclosure of relationships extending to a broad range of familial connections, including immediate and extended family members like parents, siblings, in-laws, step-relatives, grandparents, and grandchildren. Respondents must either affirm that no such relationships exist (option a) or provide specific details about any relationships with county commissioners or employees (option b). The document emphasizes the legal obligation to provide truthful information, with the declarant swearing under penalty of perjury that the disclosed information is accurate.
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Text version
Disclosure of Relationships -1
DISCLOSURE OF RELATIONSHIPS
1. This sworn statement is submitted by (firm name):
whose business address is: .
2. My name is and my relationship to the entity named above is .
3. I understand that as defined in Section 105.08, Indian River County Code, the term
“affiliate” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of the entity.
4. I understand that the relationship with a County Commissioner or County employee that must be disclosed as follows:
Self (current county employee or commissioner), father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild.
5. Based on information and belief, the statement, which I have marked below, is true in relation to the entity submitting this sworn statement. [Please select either a. or b.]
a. Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, have any relationships as defined in section 105.08, Indian River County Code, with any County Commissioner or County employee; or,
b. The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents, who are active in management of the entity have the following relationships with a County Commissioner or County employee:
Name of Affiliate of entity Name of County Commissioner or employee Relationship
6. I hereby swear, under penalty of perjury, the information provided on this form is true.
(Signature)
(Date)
| 1 This sworn statement is submitted by firm name: |
| whose business address is: |
| 2 My name is: |
| my relationship to the entity named above is: |
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